RESUMEN
Background: Managing pregnancy with post-dates is becoming a challenging issue due to increasing fetal morbidity and mortality. The study aimed to analyse the maternal and fetal outcomes of post-term pregnancies among Indian women, considering their earlier fetal maturation. Conducted over 18 months with 100 cases, the prospective observational study focused on pregnant mothers at or beyond 40 weeks gestational age, excluding those with certain medical complications.Methods: After obtaining approval from the ethics committee and informed consent from eligible participants, detailed histories and examinations were conducted, with close monitoring until delivery and postnatal care. Inclusive criteria encompassed singleton pregnancies with cephalic presentation, while exclusions included non-cephalic presentation, congenital anomalies, and various medical complications.Results: Revealed a predominance of primigravida women aged 20 to 35 years at 40 to 40 weeks and 6 days gestation. Spontaneous delivery occurred in 58%, with 90% delivering vaginally, while all multigravida births were vaginal post-induction. Cesarean sections were performed in 14%, primarily due to failed induction followed by fetal distress. Meconium-stained liquor was most prevalent at 42 weeks or later, correlating with higher perinatal mortality and NICU admissions in infants born beyond 42 weeks.Conclusions: Vigilant monitoring proved crucial in averting fetal jeopardy, emphasizing the importance of timely interventions to mitigate complications associated with post-term pregnancies. This study sheds light on the unique considerations and outcomes of post-dated pregnancies in the Indian population, contributing valuable insights for maternal and neonatal care in similar settings.
RESUMEN
Background: Pregnancy-related intrahepatic cholestasis is most prevalent hepatic disorder intense pruritus that affects the entire body including palm and sole. It is typically detected during second or third trimester. Pruritus frequently exacerbates at night, marked on the palms and soles of the feet and hands. Aim of this study was to evaluate bile acid and deranged liver function test in obstetrics cholestasis in pregnancy and to determine maternal fetal and outcomes.Methods: This prospective case series study was conducted in the Department of Obstetrics and Gynaecology, Muzaffarnagar Medical College. The present study was conducted in 50 women, who were selected from outpatient department of antenatal care from tertiary care, taken written permission before study. The medical records of all women with obstetrics cholestasis who delivered between December 2021and August 2022.Results: Subjects with IHCP has mean age of 30.11±5.03 year, found SGOT 40% in 100-200 and SGPT 44 % I (0-100) range and total bilirubin levels is 33 % in IHCP patients. In study found that LSCS due to 24% in fetal distress, 36% in MSL, 16% in IUGR, 14% preterm. Participants have 22% birth weight <2.5kg and 39 (78%) are under >2.5kg babies in IHCP patients and 24 % were underwent fetal distress and 24 % preterm delivery and 6 % got IUD . and no stillborn and 12% meconium.Conclusions: It causes maternal pruritus with impaired LFT and raised serum bile acids. Maternal morbidity is increased in terms of increased LSCS rates and discomfort due to pruritus.
RESUMEN
Background: Pruritus is a common complaint amongst pregnant woman, affecting 20% of them. This can be physiological or due to some specific dermatological conditions. Among them Intrahepatic cholestasis of pregnancy is most common cause and is characterized by pruritus with derranged liver enzymes and raised serum bile acid levels in the absence of any other liver pathology. It is associated with increased fetomaternal morbidity. Methods: This was a prospective study, conducted at Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar in the Department of Obstetrics and Gynaecology with collaboration of Dermatology Department, from March 2021 to Aug 2022. After taking ethical approval, informed consent, detailed history, clinical and biochemical assessment was done and fetomaternal outcome was recorded. Results: Prevalance of pruritus was 20.8% amongst pregnant women, of which 24% patients were diagnosed having intrahepatic cholestasis of pregnancy (ICP) and 76% were labelled as NON ICP patients. Among NON ICP patients prevalence of pruritic urticarial papules and plaques of pregnancy was 32.10%. Majority intrahepatic cholestasis of pregnancy patients had moderately affected quality of life. Majority of pruritic patients had normal bilirubin levels and all intrahepatic cholestasis of pregnancy patients had raised serum Alanine transaminase, Aspartate transaminase, bile acids values. Meconium stained liquor, preterm delivery, Low birth weight, cesarean rates, NICU admissions rates were higher in intrahepatic cholestasis of pregnancy patients. Conclusions: Pruritus in pregnancy is a common condition. Dermatological opinion along with liver function tests should be done to know about the cause and severity of pruritus. Intrahepatic cholestasis of pregnancy (ICP) affects perinatal outcomes. So patients should be closely monitored to improve the fetomaternal outcome.
RESUMEN
Background: Pruritus is a common complaint amongst pregnant woman, affecting 20% of them. This can be physiological or due to some specific dermatological conditions. Among them Intrahepatic cholestasis of pregnancy is most common cause and is characterized by pruritus with derranged liver enzymes and raised serum bile acid levels in the absence of any other liver pathology. It is associated with increased fetomaternal morbidity. Methods: This was a prospective study, conducted at Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar in the Department of Obstetrics and Gynaecology with collaboration of Dermatology Department, from March 2021 to Aug 2022. After taking ethical approval, informed consent, detailed history, clinical and biochemical assessment was done and fetomaternal outcome was recorded. Results: Prevalance of pruritus was 20.8% amongst pregnant women, of which 24% patients were diagnosed having intrahepatic cholestasis of pregnancy (ICP) and 76% were labelled as NON ICP patients. Among NON ICP patients prevalence of pruritic urticarial papules and plaques of pregnancy was 32.10%. Majority intrahepatic cholestasis of pregnancy patients had moderately affected quality of life. Majority of pruritic patients had normal bilirubin levels and all intrahepatic cholestasis of pregnancy patients had raised serum Alanine transaminase, Aspartate transaminase, bile acids values. Meconium stained liquor, preterm delivery, Low birth weight, cesarean rates, NICU admissions rates were higher in intrahepatic cholestasis of pregnancy patients. Conclusions: Pruritus in pregnancy is a common condition. Dermatological opinion along with liver function tests should be done to know about the cause and severity of pruritus. Intrahepatic cholestasis of pregnancy (ICP) affects perinatal outcomes. So patients should be closely monitored to improve the fetomaternal outcome.
RESUMEN
Objective@#This study aimed to determine the maternal clinical factors associated with neonatal respiratory morbidity and other adverse neonatal outcomes in meconium-stained labor among term parturients.@*Methodology@#A retrospective cohort study was done on admitted obstetric patients with term gestation and had meconium-stained labor. Maternal clinical factors such as age, parity, gestational age, manner of delivery, duration of labor, presence of term prelabor rupture of membranes (PROM), character of meconium-stained liquor (MSL), and presence of comorbidities were identified and analyzed to determine their association with neonatal respiratory morbidity and other adverse neonatal outcomes. @*Results@#In this study, there were 986 cases identified to have meconium-stained labor, and 168 developed neonatal respiratory morbidity. As to primary outcome, maternal clinical factors, such as age >35 years, multiparity, age of gestation >41 weeks, prolonged labor, presence of PROM, significant MSL upon admission, presence of change from nonsignificant to significant MSL, presence of intrauterine growth restriction, and hypertension, were all shown to be statistically significant. @*Conclusion@#The presence of maternal clinical factors in meconium-stained labor was observed to be a risk factor in developing neonatal respiratory morbidity and other adverse neonatal outcomes. Hence, identification of maternal risk factors and early detection of meconium-stained amniotic fluid are vital in administering timely intervention to labor and delivery to reduce neonatal complications.
Asunto(s)
Enfermedades del Recién NacidoRESUMEN
Background: The objective of this study was to determine the significance of meconium staining of the amniotic fluid and find out an appropriate mode of delivery in women with MSL.Methods: A retrospective study was carried out in Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, a tertiary government hospital, New Delhi over a time period of 1 year between 2009 to 2010 on 1425 consecutive women of which 142 women were diagnosed as having meconium staining of the amniotic fluid during labour. All cases were critically analysed and maternal and fetal outcomes were studied in these women.Results: The incidence of MSL was 10% (142/1425), 45% had thin MSL and 55% had thick MSL. In women with thick MSL, 85% had early thick MSL and 15% had late thick MSL. In women who had early thick MSL (n=66), 55 (83.3%) delivered by LSCS and 11 (16.7%) delivered vaginally. On correlating the perinatal outcome with mode of delivery irrespective of fetal heart rate abnormality in early thick MSL, it was seen that the perinatal outcome was significantly affected by mode of delivery. The rates of respiratory distress and MAS was significantly higher in babies who delivered vaginally compared to those by LSCS (18% & 100% vs 9% & 40%, p=0.012, RR- 5.2 [95% CI: 1.8-3.42]. There were no perinatal mortality in early thick MSL.Conclusions: In distinguishing between thick and thin meconium, it was noted that finding of thick meconium in the latent phase of labour (i.e. early thick MSL) is ominous and demands an urgent caesarean delivery.
RESUMEN
Background: It has been since antiquity that the importance of amniotic fluid and fetal growth with perinatal outcome is being documented. But the lacunae lies in studying the relationship between borderline amniotic fluid and perinatal outcome. The following study was undertaken to provide recent data that would help predict perinatal outcome in borderline AFI pregnancies.Methods: About 144 patients were considered in the study OPD/IPD patients in obstetrics and gynecology department in Bhabha Atomic Research Centre and Hospital, with about 72 cases with borderline amniotic fluid index (5-8 cm) and controls with amniotic fluid index ≥9-25 cm. Patients were selected and subjected to history taking, examination, ultrasound test with doppler studies and perinatal outcome documented over a period of one year.Results: The incidence of borderline AFI in my study was 16%. 58% were primigravidas. Meconium stained liquor was found in 18% cases compared to 7% controls. Low birth weight was found in 12.5% cases and 2.7% in controls. On applying statistical test analysis chi square test, it was found that borderline amniotic fluid index in relation to presence of meconium stained amniotic fluid and low birth weight, p value was found to be statistically significant (<0.05).Conclusions: Borderline amniotic fluid and perinatal outcome had significant relationship in terms of meconium stained liquor and birth weight while rest had no significance. Thus, borderline amniotic fluid patients require vigilant fetal surveillance.
RESUMEN
Umbilical cord contains two arteries and one vein connecting fetus to the placenta and is responsible for blood flow between the two. It is surrounded by Wharton’s jelly which is a gelatinous substance and functions as adventitia layer of umbilical vessels, thereby providing insulation and protection to the umbilical cord. Umbilical cord abnormalities are associated with poor perinatal outcomes. Very few cases of absent Wharton’s jelly are reported in literature. Ours might be the 8th one in which we did a lower segment caesarean section for meconium stained liquor but the baby died after 12 hours.
RESUMEN
Background: Pre labor Rupture of membranes is a common obstetrical problem, significant event as it transforms an ordinary pregnancy into a high risk one. Majority of cases of PROM - of about 60% occur after 37 completed weeks Induction of labour is artificial. Misoprostol is receiving attention as a cervical modifier and labour induction agent. This study compares the safety and efficacy of Misoprostol with Oxytocin in labour induction in term pre labour rupture of membranes. Objective of this study was to compare the safety and efficacy of Misoprostol with that of Oxytocin in labour induction in PROM. The effects were compared between primipara and multipara in a selected sample.Methods: General condition is assessed by pulse rate, blood pressure, height, weight with particular attention to pedal odema, anemia. Cardiovascular and respiratory systems were examined, rule out cephalo pelvic disproportion and for Bishop’s scoring. USG for foetal maturity, Liquor status and for foetal well-being. Admission CTG.Results: There is no significant difference was observed between two groups either in vaginal delivery or in incidence of LSCS. Mean induction delivery interval in misoprostol group for nullipara is 8.5 hours. For multipara it is 6.6 hours. And in oxytocin group for nullipara is 10:4 hours. In multipara it is 6.5 for primipara it was significantly reduced in misoprostol group compared to syntocinon group.Conclusions: Misoprostol is an effective, cheap, safe, stable at room temperature and easy to use if it is used in appropriate dosage for induction of labour in pre-labour rupture of membranes at term.
RESUMEN
Background: Pregnancy and childbirth is normal physiological process with great pathological potential. The obstetricians are more concerned with the early recognition of fetal distress during labour and such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Cardiotocography as a part of biophysical profile has become an established diagnostic tool for fetal surveillance. To compare early perinatal outcome of normal and abnormal cardiotocography in terms of APGAR scores, need for neonatal resuscitation, NICU admission, perinatal death and mode of delivery.Methods: It was a cross-sectional study. 200 nulliparous/multiparous women with singleton pregnancy in cephalic presentation at gestational age 37-42 weeks in latent stage of labor were enrolled in the study and subjected to admission test in left lateral position using fetal monitor. Baseline FHR and contraction pattern were determined for 20 minutes and classification of patients was done into normal, and suspicious or abnormal according to the FIGO guidelines 2015.Results: Low APGAR scores, rate of LSCS, need for neonatal resuscitation, neonatal admission were more in the abnormal cardiotocography group. Cardiotocography in the current study has high sensitivity and high negative predictive value for detecting fetal distress.Conclusions: From the analysis of this study, it would be safe to conclude that an ominous cardiotocography should be managed appropriately without delay and obstetrician should be vigilant in suspicious as well as in normal admission test group for timely intervention for bettering the neonatal outcome.
RESUMEN
Background: Modified WHO Partograph is a simple, inexpensive pre-printed form on which labour observation are recorded. It generally comprises three sections of information: maternal condition, fetal condition and labor progress. To study on usefulness of Modified WHO Partograph in management of labour of low risk women, this indirectly improved maternal and perinatal outcome.Methods: In this study the progress of labour of 150 women with uncomplicated full term pregnancies with cephalic presentation in active labour was studied using modified WHO partograph. 150 historical matched controls comprising of low risk women who delivered without the use of partograph were identified from the labour register and their course of labour studied. The hospital records were studied to obtain the demographic variables. Maternal and perinatal outcome was analyzed for both cases and controls.Results: The emergency cesarean section rate was reduced from 38.7% in controls to 24.7% in cases and both are significant statistically. None of the cases had labour beyond 16 hours, thus indicating significant reduction in prolonged labour. Neonatal intensive care admissions decreased from 18.6% in controls to 6% in cases indicating an improved maternal and neonatal outcome.Conclusions: Modified WHO Partograph work as “early alarming warning system” which help in detecting delayed progress of labour which improves maternal as well as perinatal outcome.